糖尿病视网膜病变患者血浆血栓调节蛋白水平研究

Study on the Levels of Plasma Thrombomodulin in Patients of Diabetic Retinopathy

目的:观察患有不同程度视网膜病变的糖尿病患者血浆血栓调节蛋白(thrombomodulin,TM)的变化,了解这种因子在糖尿病视网膜病变发病中的意义。方法:将糖尿病患者按眼底视网膜病变程度分为3组:无糖尿病视网膜病变期(no diabetic retinopathy,NDR)20例,单纯型糖尿病视网膜病变期(simple diabeticretinopathy,SDR)20例,增殖型糖尿病视网膜病变期(proliferative diabetic retinopathy,PDR)20例,以及相应年龄段的健康正常人作为对照组(CONTROL)30例,分别用ELISA方法测定血浆TM浓度,观察各组变化,同时研究TM与病程、血糖、血脂、血黏度、纤维蛋白原、肾功能、血压的相关性。结果:①NDR、SDR、PDR3组血浆TM水平均明显高于正常对照组(P<0.05),而且PDR组血浆TM水平高于SDR组(P<0.05),SDR组血浆TM水平高于NDR组(P<0.05);②血浆TM分别与病程、空腹血糖、糖化血红蛋白、胆固醇、低密度脂蛋白、血肌酐、纤维蛋白原、全血低切黏度、血浆黏度呈显著正相关。结论:糖尿病患者血中TM水平反映了血管内皮细胞受损程度,随着内皮细胞损伤程度加重,TM值上升,糖尿病视网膜病变的程度逐渐加重,眼底出现了增殖型视网膜病变。

Objective： To measure the plasma levels of thrombomodulin （TM） in patients with different degrees of diabetic retinopathy and to study the significance of TM in the pathogenesis of diabetic retinopathy. Methods： 60 cases of diabetic patients were divided into three groups according to the degree of the severity of diabetic retinopathy, including no diabetic retinopathy（NDR） group, simple diabetic retinopathy（SDR）group, and proliferative diabetic retinopathy（PDR） group, while 30 cases of normal people were also checked as the control group. The plasma levels of TM were examined by the use of ELISA, The relationship between TM and course , glucose, blood fat, blood viscosity, fibrin, renal fuction, blood pressure was also investigated. Result： （1） The plasma TM level in NDR, SDR, PDR group was higher than those in the control group. （P 〈 0.05） . The plasma TM level was higher in PDR group than those in SDR and NDR groups , and it was also higher in SDR group than those in NDR group（P 〈 0.05）. （2） Plasmer TM was correlated with the duration of disease,fasting blood glucose, glycosylated hemoglobin, total cholesterol, low density lipoprotein, creatinine, fibrin, whole blood hypotomy viscosity, blood viscosity. Conclusion： The levels of plasma TM in patients of diabetic retinopathy increased as retinopathy progressed, ocular vascular injuries may correlated with systemic vascular injuries. Therefore, the progress of retinopathy may be predicted by monitoring plasma thrombomodulin levels in selected patients.